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General NPI Number Information
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NPI Number | 1962782680
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Entity Type | Organization
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Legal Business Name | J.WARREN HILDRETH, JR., DDS PA
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Dates
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Enumeration Date | 08/25/2011
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Last Update Date | 08/25/2011
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Provider Practice Location Address
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Address Line | 310 W BERTRAND AVE
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City | SAINT MARYS
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State | KS
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Zip | 66536-1615
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Country | US
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Telephone | 785-437-2771
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Fax | 785-321-1773
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Provider Business Mailing Address
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Address Line | 310 W BERTRAND AVE
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City | SAINT MARYS
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State | KS
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Zip | 66536-1615
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Country | US
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Telephone | 785-456-7083
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Fax | 785-456-6520
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAY WARREN HILDRETH JR.
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Credential | DDS
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Telephone | 785-456-7083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4680
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License Number State | KS
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